To ensure our soldiers stay Army Strong on the battlefield, they must receive the very best medical care and support. The U.S. Army Communications Electronics Command Software Engineering Command (CECOM SEC) and the Defense Health Services System Program Executive Office (DHSS PEO) have partnered to improve the software that supports Army medicine.
The CECOM SEC provides life cycle software solutions and services that enable war-fighting superiority and information dominance across the enterprise. The DHSS PEO, a component of the new Defense Health Agency (DHA), builds and maintains medical software systems that provide clinical support, medical logistics, and health care resource management.
The systems managed by CECOM SEC personnel at the DHSS PEO directly support all aspects of military health care. In theater, these systems ensure the availability of medical supplies, protect soldiers from industrial and environmental hazards, and manage the biomedical equipment used during medical evacuations. These systems also support "brick and mortar" capabilities including medical billing, prescription refills, and access to personal health data through the DoD Blue Button. The DoD Blue Button provides eligible beneficiaries, who regularly receive treatment at a military hospital or clinic, the ability to view, download, print, and or share their personal health data.
Together, the DHSS PEO and the CECOM SEC are leading the charge on the Agile software development method known as Scrum. In 2012, CECOM SEC staff assigned to the DHSS PEO began the adoption of Scrum to improve the quality and reduce the time, cost, and risk associated with the software development process. Today, DHSS PEO project teams are using Scrum to enhance software that will optimize the delivery of medical supplies, improve human resource management, and enrich the health care experience of DHA patients around the globe.
Software development: Scrum versus Waterfall
Scrum represents a fundamental shift from the traditional Waterfall software development model, in use today by most DOD teams.
Figure 1: Traditional Waterfall software development model
In the traditional Waterfall software development model (Figure 1), projects follow a set of linear steps to design, build, and deliver the requested customer changes. While there are feedback loops, these loops can be very time- and cost-intensive, as major components of the solution may need to be reworked over and over. These linear steps also require multiple customer reviews and approvals (overhead) to make sure the final product is in line with the customer request. As Waterfall projects are planned out at the beginning, based on initial requirements/assumptions, an inherent flaw of this approach is the belief the customer and the delivery teams know everything up front, and that there will be little to no changes during the execution of the project. It is common that changes will occur; requirements, priority, customer, stakeholder, etc., changes usually impact the execution of the project and the delivery of the final solution.
Figure 2: Scrum software development model
In contrast, the Scrum software development model welcomes and supports change. Scrum (Figure 2) incorporates short, repeating software development cycles called sprints. During sprints, customers and the software development teams work closely together to prioritize and complete the work. This allows sprint teams to deliver software releases early and often, which allows the customers and sprint teams to learn and improve as they go.
Moving from Waterfall to Scrum
The DHSS PEO adoption of Scrum required organization-wide training, new processes, and continuous communication. The first step in the transformation was to ensure all DHSS PEO government and contractor teams received training in Scrum basics. Once training was complete, new Scrum processes, development standards, and templates were created to provide a framework for success. These new templates and tools were tested in pilot projects and adjusted when needed. Finally, the successes and challenges of this new process were communicated throughout the organization to foster understanding and improvement.
Benefits to the Army
The adoption of the Scrum method improves the delivery of software to Army customers and allows them to perform new medical functions more quickly, with fewer errors.
Recently, Army representatives participated in Agile sprint sessions focused on enhancing the Defense Medical Human Resources System-internet (DMHRSi), a system that helps the Army manage current and future medical human resources needs. The objective was to develop an improved process to update the Total Army Authorizations Document System (TAADS) and align the DMHRSi with current Army manpower data.
Two successive sprints were required to develop the code, test the results, and implement the improved process. The Army representatives worked closely with the DMHRSi team, participating in daily sprint calls, onsite demonstrations, and final product acceptance. The process was successful and the new, deployed functionality provides the capability for the Army customers to implement changes to the Army Table of Distribution and Allowance (TDA).
Since implementing Scrum, the DMHRSi project has reduced the average number of days required to deliver a new software release from 419 days down to 58 days (Figure 3). This represents a time-to-market improvement of almost 400 percent.
Figure 3: DMHRSi improves time to market with Scrum
The Scrum method allows DMHRSi customers to reprioritize requirements as their missions and needs change, which the sprint teams then act on and deliver. This collaborative and responsive framework has led to increased customer satisfaction and a reduction in Help Desk tickets for the DMHRSi application. As a measure of the DMHRSi applications success under Scrum, the number of DMHRSi Help Desk tickets has decreased by 87 percent (Figure 4).
Figure 4: DMHRSi reduced the number of Help Desk tickets with Scrum
"The Agile Scrum process allows our customers to prioritize the capabilities they need immediately, and the sprint teams to deliver new software in a timely manner," said Chris Harrington, CECOM civilian and deputy program manager for the DHSS PEO. "The continuous feedback in Agile Scrum allows us to make course adjustment as needed in tandem with our customers and deliver a better product."
The CECOM SEC and the DHSS PEO are pleased with the success of the Scrum implementation. The Scrum method creates a culture of collaboration that allows the DHSS PEO to be responsive to Army customers. These innovative efforts will continue to support the medical care provided to Army service members, their families, and military retirees worldwide.
This article was coauthored with Edd Welsch.